“Working in partnerships to ensure the global survival of amphibians, focusing on those that can not be safeguarded in nature. Amphibian Ark is possible due to your generous support..”

Throughout the practice of medicine, the paradigm of standardizing diagnosis — knowing how to recognize when different patients have the same disease process — has allowed standardized treatment by the protocols that have the best statistical evidence of success. But this standardized and evidence-based way of treating patients has been countered by the recognition that individuals differ in their responses to treatment for a variety of reasons. So standardization has begun to be counterbalanced by a new paradigm of personalized medicine, which attempts to further refine treatment choices by analyzing what individual factors in a patient are likely to influence treatment response (although by and large the managed care companies do not like the anecdotal and amorphous nature of the approach). There has been a growing recognition of ethnic, age-related, and gender-based distinctions in disease expression and treatment response. A large part of these individual differences is based in physiological distinctions based in genetic differences, so it is not surprising that the personalized medicine movement is fist-in-glove with the genomics mavens. But even the gene sherpas recognize that, for the foreseeable future, individual genetic testing will be a piecemeal, minor contribution to predicting disease risk and treatment response relative to the more simple and time-honored medical practice of taking a family history.

In the psychiatric field, where I practice, attention to personalizing care has, of course, always been a relatively more important counterbalance to the standardization paradigm that has infected the rest of medicine. One reason, which goes without saying, is that ethnic, cultural, gender, community and family cultural differences shape illness behavior and expectancies and beliefs about treatment responses. The art of psychiatry is in large measure parsing out and mobilizing such individual factors to maximize recovery and empowerment. And genetic/constitutional variables also shape psychiatric treatment response. If you read psychiatric evaluations, you find that the family history section of the write-up is generally more attended to than in other medical fields. Conclusions about what psychiatric disease the presenting symptoms might represent are often strongly shaped by what diagnoses blood relatives have been known to have. Some of us place great stock in factoring the responses of relatives to specific medications (antidepressants, antipsychotics etc.) in choosing which therapies to prescribe to our patients.

But the atomization of communities, attenuation of family structure and dispersal of relatives have crippled our access to and familiarity with our families’ medical histories. The emphasis physicians would like to place on such factors is often defeated by patients’ impoverished awareness of their families’ histories. Deliberate, often daunting, efforts on patients’ parts are necessary to counter this. I’ve seen suggestions that patients use holiday family gatherings as an opportunity to take a detailed health history from their relatives:

While the intention is good, however, the clinical emphasis may not exactly be in keeping with holiday cheer and the clinical interview not exactly one of the joys of the season. You may want to make a point of finding another time, soon, to query relatives about their health histories, especially elderly relatives whose wealth of information could soon be lost. This site from the Dept. of Health and Human Services outliens the Surgeon General’s Family History Initiative and provides online resources for information-gathering.

As we psychiatric practitioners also find when we encourage our patients to contact relatives for their health histories, these conversations are also beneficial in other ways. Nonspecific factors of renewal of contact with family members, facilitation of communication channels, and gaining a mutual appreciation of at least some dimensions of our relatives’ struggles with adversities, are good for the soul, and good for one’s health, in general.

Operation Clambake: “This is the cracked ban lists for the Scientology censorware software (aka ScenioSitter) – all thanks go to the guys at http://fravia.org/saruma1.htm who cracked CyberSitter – and Anti-Cult who found their page. ScenioSitter is still being analyzed by critics of the cult, new information will be added to this site.”

• List of sites and domains
• List of newsgroups
• List of words and names
• More forbidden words and names

Throughout the practice of medicine, the paradigm of standardizing diagnosis — knowing how to recognize when different patients have the same disease process — has allowed standardized treatment by the protocols that have the best statistical evidence of success. But this standardized and evidence-based way of treating patients has been countered by the recognition that individuals differ in their responses to treatment for a variety of reasons. So standardization has begun to be counterbalanced by a new paradigm of personalized medicine, which attempts to further refine treatment choices by analyzing what individual factors in a patient are likely to influence treatment response (although by and large the managed care companies do not like the anecdotal and amorphous nature of the approach). There has been a growing recognition of ethnic, age-related, and gender-based distinctions in disease expression and treatment response. A large part of these individual differences is based in physiological distinctions based in genetic differences, so it is not surprising that the personalized medicine movement is fist-in-glove with the genomics mavens. But even the gene sherpas recognize that, for the foreseeable future, individual genetic testing will be a piecemeal, minor contribution to predicting disease risk and treatment response relative to the more simple and time-honored medical practice of taking a family history.

In the psychiatric field, where I practice, attention to personalizing care has, of course, always been a relatively more important counterbalance to the standardization paradigm that has infected the rest of medicine. One reason, which goes without saying, is that ethnic, cultural, gender, community and family cultural differences shape illness behavior and expectancies and beliefs about treatment responses. The art of psychiatry is in large measure parsing out and mobilizing such individual factors to maximize recovery and empowerment. And genetic/constitutional variables also shape psychiatric treatment response. If you read psychiatric evaluations, you find that the family history section of the write-up is generally more attended to than in other medical fields. Conclusions about what psychiatric disease the presenting symptoms might represent are often strongly shaped by what diagnoses blood relatives have been known to have. Some of us place great stock in factoring the responses of relatives to specific medications (antidepressants, antipsychotics etc.) in choosing which therapies to prescribe to our patients.

But the atomization of communities, attenuation of family structure and dispersal of relatives have crippled our access to and familiarity with our families’ medical histories. The emphasis physicians would like to place on such factors is often defeated by patients’ impoverished awareness of their families’ histories. Deliberate, often daunting, efforts on patients’ parts are necessary to counter this. I’ve seen suggestions that patients use holiday family gatherings as an opportunity to take a detailed health history from their relatives:

While the intention is good, however, the clinical emphasis may not exactly be in keeping with holiday cheer and the clinical interview not exactly one of the joys of the season. You may want to make a point of finding another time, soon, to query relatives about their health histories, especially elderly relatives whose wealth of information could soon be lost. This site from the Dept. of Health and Human Services outliens the Surgeon General’s Family History Initiative and provides online resources for information-gathering.

As we psychiatric practitioners also find when we encourage our patients to contact relatives for their health histories, these conversations are also beneficial in other ways. Nonspecific factors of renewal of contact with family members, facilitation of communication channels, and gaining a mutual appreciation of at least some dimensions of our relatives’ struggles with adversities, are good for the soul, and good for one’s health, in general.